Department Of Niswan Wa Qabalat, Aligarh Muslim University.
Menorrhagia is a major public health problem for women of reproductive age, is defined as clinically as menstrual blood loss equal to or greater than 80 mL per cycle and/or a menstrual duration longer than 7 days. It affects 20 to 30% of women at some time or other with significant adverse effects on the quality of life in terms of anemia, cost of sanitary pads, and interference with day to day activities. It is generally caused by condition affecting the uterus or its vascularity such as myoma of uterus ,uterine polyp, adenomyosis, endometrial hyperplasia & disturbances of function of hypothalamic pituitary ovarian (H-P-O)axis Conservative medical treatment for the management of menorrhagia may result in a substantial reduction in menstrual blood loss thereby reducing the incidence of anemia. But these therapies have their own side effects including GIT disturbances, nausea, vomiting, obesity, liver diseases, thromboembolic diseases etc. Such a situation invites some alternative treatment for menorrhagia.. According to Unani Scholar, Kasrat-e-tams caused by Abnormal temperament of uterus & body, Dominance of bile humor (Ghalba-e- Khilte Safra wa Sauda), Congestion in the body(Imtila-e-badan) ,Decreased viscosity& liquefaction of blood, Weakeness in retentive(Quwat-e-Masika) power , Increase in expulsive (Quwate Dafiya) power. In Unani medicine the line of treatment (Usoole Ilaj) for Menorrhagia is to remove the cause at first step by those drugs which possess the properties of Qabiz and Habis(astringent and styptic) Muqawi Rahem advia (uterine tonic) to strengthen the uterus . Keeping in view , the Unani compound formulation (powder of Sang-e- Jarahat, Mazu Sabz, kath Safed and Maeen) has been envisaged to conduct the study on clinical aspect.This case series includes 5 diagnosed patient of menorrhagia.
Menorrhagia is a major public health problem, [1] for women of reproductive age [2] and considered to be one of the most significant causes of ill health in women [3]. The term menorrhagia is derived from Greek word ‘men’ meaning menses and ‘rrhagia’ meaning burst forth. Menorrhagia is defined as cyclic bleeding at normal interval, the bleeding is either excessive in amount (>80ml) or duration (>7days) or both [4].Menorrhagia is essentially a symptom and not itself a disease, it affects 20 to 30% of women at some time or other with significant adverse effects on the quality of life in terms of anemia, cost of sanitary pads, and interference with day to day activities[5]. According to the report of World Health Organization 18 million women between the age group of 30–50 years recognize their menstrual blood loss (MBL) excessively high[6]. It is generally caused by condition affecting the uterus or its vascularity, rather than any disturbances of function of the hypothalamic pituitary ovarian (H-P-O) axis. Whenever the uterine endometrial surface is enlarged, the bleeding surface is increased, contributing to excessive bleeding, such condition prevails in uterine fibroids, adenomyosis, uterine polyp, myohyperplasia and endometrial hyperplasia.. Conservative medical treatment for the management of menorrhagia may result in a substantial reduction in menstrual blood loss thereby reducing the incidence of anemia. But these therapies have their own side effects including GIT disturbances, nausea, vomiting, obesity, liver diseases, thromboembolic diseases etc.[7]. Such a situation invites some alternative treatment for menorrhagia. In Unani system of medicine menorrhagia (Kasrat-e-Tams) defined as excessive Menstrual Bleeding either the bleeding is excessive in amount or duration. Scholars were of opinion that Kasrate Tams(menorrhagia) is caused by Sue Mizaj Rehm wa Badan (abnormal temperament of uterus and body), Amraze Rahem (diseases of uterus), Ghalba e Khilte` Safra wa sauda (dominance of bile humor), Imtila e Badan (congestion in the body), Riqqat and Latafate Khoon (decreased viscosity and liquefaction of blood), etc. They also said Zoafe Quwate Masika (weakness in retentive power) and Qawi Quwate Dafiya (increase in expulsive power) lead to this disease [8,9,] If not treated in time, leads to complications such as indigestion, weakness, abortion, defect in implantation, and intrauterine growth retardation [8]. In Unani medicine the line of treatment (Usoole Ilaj) for Menorrhagia is to remove the cause at first step by those drugs which possess the properties of Qabiz and Habis(astringent and styptic) Muqawi Rahem advia (uterine tonic) to strengthen the uterus [9]. Treatment objective in menorrhagia is to improve quality of life as well as alleviating heavy menstrual flow. Although to treat menorrhagia non-steroidal anti- inflammatory drugs such as mefenamic acid, antifibrinolytic agents like tranexamic acid, hormonal drugs including oral contraceptive pills, oral progestin, and levonorgestrel releasing intrauterine devices are available as conventional treatment, side effects related to these drugs as well as contraindication in some women are the major problems [10]. Hence despite a wide range of treatment options for the management of menorrhagia over recent years there is still an acute need to look for better option and some alternative treatment with least side effects.The Unani compound formulation (powder of Sang-e- Jarahat, Mazu Sabz, kath Safed and Maeen) has been envisaged to conduct the study on clinical aspect, as no clinical study has been done so far. The ingredients of the said formulation possess the medicinal properties same as mentioned by Unani scholars in their treatise i.e .Habis (styptic), Qabiz (astringent), Muqauwwi rahem (uterine tonic) [11].
Patient Profile 1
A married patient P2L2A0 aged 26years came to gynaecology O.P.D of AKTCH,AMU,Aligarh .She complained of heavy menstrual bleeding since 5 months associated with fatigue and general weakeness.Her menstrual cycle was regular,cycle length was 25-30 days with a duration of flow 6-8 days that was heavy flow and there was a history of passing blood clots.The bleeding was assessed by PBAC score,patient undergo surgery of cholecystectomy 2 yr back.There was no past history of Diabetes mellitus ,Thyroid dysfunction,bleeding disorder, blood transfusion.There was no history of of ovarian ,endometrial,or breast cancer in her family.The history of OCPs and Cu T was negative.
Clinical Findings
On Physical Examination: Pallor was positive,no edema,
On Pelvic Examination: there was no polyp or growth seen,uterus was anteverted,mobile,firm, and fornices were non tender.
Laboratory Findings: includes Hb%-9gm ,Blood sugar® -100mg% .RFT and LFT before and after treatment was done to assess any side effects of drug and Trans abdominal scan was normal except worm infestation .Her Vitals was also normal ;BP-122/88 mmHg,PR-82/min,Weight -56 kg,Spo2 -100%.Hence patient was subjected to safoof of Sang-jarahat,Mazu sabz,kath safed,Mayeen,4gm BD for 5 days or till bleeding stops for three consecutive menstrual cycle.
Patient Profile 2
An unmarried patient was 18 years old came to OPD with the complaint of Prolong menstrual bleeding from 2 month.Her menstrual cycle was regular,but the duration of flow increases i.e 10-12 days which was moderate in amount and there was a history of passing blood clots.The bleeding was assessed by PBAC score. Proper history was taken, no medical history notable for systemic hypertension, type II diabetes,thyroid dysfunction, no drug history of hypertensive drugs, no blood transfusion history and no history of endometrial ,ovarian cancer in her family.
Clinical Findings
On Physical Examination: Pallor was positive,no edema,
On Pelvic Examination: there was no growth seen ,uterus was anteverted,mobile,firm, and fornices were non tender.
On Investigation: Hb%,-7gm%,RBS-90,BT/CT-2:1/5:2min ,along with RFT and LFT before and after treatment was done to assess any side effect of drugs.Ultrasonography was also done by to detect any pelvic pathology.On the basis of available information patient received unani treatment of safoof of Sang-jarahat,Mazu sabz,kath safed,Mayeen,4gm BD for 5 days or till bleeding stops for three consecutive menstrual cycle.
Patient Profile 3
A 27 yr old female (P3L3A0) came to gynaecology OPD with the complaints of heavy &Prolong vaginal bleeding during menses from last 3 months.Her menstrual cycle was regular,Bleeding is heavy and duration of flow is increases from 10-14 days along with passage of large clots.There is no history of intemenstrual bleeding,bleeding was assessed by PBAC score. There was no past history of Diabetes mellitus ,Thyroid dysfunction,bleeding disorder, blood transfusion.There was no history of of ovarian ,endometrial,or breast cancer in her family.The history of OCPs and Cu T was negative.
Clinical Findings
On Physical Examination: Pallor was positive,no edema,
On Pelvic Examination: there was no polyp or growth seen, uterus was anteverted, mobile, firm, and fornices were non tender. Routine investigation was also done like Hb% -9gm%, Urine Routine and microscopy was normal, BT/CT-was also normal(2:40/6:20min). LFT&RFT before and after treatment was done to assess any side effects, no pelvic pathology present in Ultrasonography. Her Vital was also in normal limit(B.P-116/80mmHg,P.R-84/min,) Hence patient was subjected to safoof of Sang-jarahat,Mazu sabz,kath safed,Mayeen,4gm BD for 5 days or till bleeding stops for three consecutive menstrual cycle.
Patient Profile 4
Case 4 was a 26 yr old married(P2L2A0) female who came to OPD with the complaint of heavy and prolong bleeding during menses from 4 month associated with fatigue and general weakeness. .Her menstrual cycle was regular,cycle length was 28-32days with a duration of flow 4-5 days that was heavy flow(4-5 Pads used/day )and there was a history of passing large blood clots.Her past menstrual cycle was also regularThe bleeding was assessed by PBAC score. There was no past history of Diabetes mellitus ,Thyroid dysfunction,bleeding disorder, blood transfusion.There was no history of of ovarian ,endometrial,or breast cancer in her family.There is a history of contraception by mechanical methods since 1 yrs.
Clinical Findings
On Physical Examination: Pallor was positive,no edema,
On Pelvic Examination: there was no polyp or growth seen,uterus was anteverted,mobile,firm, and fornices were non tender.
Routine investigation was also done like Hb% -9.8gm%,Urine Routine and microscopy was normal, BT/CT-was also normal(3/6min). LFT&RFT before and after treatment was done to assess any side effects.Usg shows Normal scan except left ovarian hemorrhagic cyst.Her Vital was also in normal limit(B.P-120/80mmHg,P.R-88/min,)
Patient Profile 5
A 32 yr old female(P2L2A1) female came to OPD with the complaint of heavy prevaginal bleeding during menses associated with suprapubic pain and general weakeness.Her menstrual cycle was regular,cycle length was 24 days with a duration of flow 4-7 days,bleeding was heavy (6 pads used /day) along with passing of big clots.Her past menstrual cycle was also regular. regularThe bleeding was assessed by PBAC score. There was no past history of Diabetes mellitus ,Thyroid dysfunction,bleeding disorder, blood transfusion.There was no history of menstrual irregularities in her family,No surgical history present.
Clinical Findings
On Physical Examination: Pallor was positive,no edema,
On Pelvic Examination: there was no polyp or growth seen,uterus was anteverted,mobile,firm, and fornices were non tender. Routine investigation was also done like Hb% -8gm% R.B.S-80mg%,Urine Routine and microscopy was normal,BT/CT-was also normal(3:1/5:2 min). LFT&RFT before and after treatment was done to assess any side effects.Usg shows Normal scan except functional cyst in left ovary.Her Vital was also in normal limit(B.P-124/86mmHg,P.R-90/min.
Diagnostic Assessment
Diagnosis was made by taking proper menstrual history, assessment of blood loss . Patients went through for both general and systemic examination. The bleeding was assessed by PBAC score.
Therapeutic Intervention
After an initial assessment of the patient, Compound formulation of powder of sang-e-Jarahat(hydrated magnesium silicate),Mazu Sabz(Quercus infectoria),Kath Safed(Acacia catechu) and Maeen Khurd(Tamarix gallica) in equal quantity was used per orally 4gm twice daily from day 1 to day 5 or till bleeding stop of the menstrual cycle for three consecutive cycle. As per references available in the classical Unani literature, Unani formulation (Safoof of Sang-e-jarahat,Mazu sabz,Kath safed,Maeen) is a pharmacopoeil formulation taken from Akseere-Azam, Published by Idara Kitabusshifa, New Dehli.
Follow-Up & Outcome
Follow-up is during and after every menstrual cycle upto three consecutive menstrual cycle and after completion of study period another next 3 months to observe the progression and regression of symptoms. .This compound unani formulation was prescribed for 3 consecutive menstrual cycle. Thereafter, improvement was noticed in the patient’s complaints. Significant improvement was observed during follow-ups. At the end of 2nd months reduction in amount of flow (number of pads per cycle) used by the patient, decrease in blood clot ,improvement in PBAC score(which was less than90 points).A regular menstrual cycle was achieved by the end of the 3rd month.Patient’s general condition was also improved,
DISCUSSION
Heavy menstrual loss is one of the most frequently encountered symptoms in gynaecology, which lead to a significant interference with women’s physical ,emotional,social and material quality of life,and a considerable economic burden on the healthcare system.Excessive regular blood loss of this magnitude leads to significant adverse impact on woman’s iron metabolism causing iron deficiency anaemia.Most of the medicinal herbs contains tannins and are effective to control bleeding.Tannins have an astringent action and can contact capillary endothelium, Thus results in decreased exudation and menstrual blood loss .Eminent Unani scholar described various unani formulation in the authentic book for treatment of Menorrhagia(Kasrat-e-tams).All the cases chosen for study showed improvement improvement .As per Unani concept of management the powdered Sange jarahat,Mazu sabz,kath safed,Maeen has the properties of Astringent,Styptic properties which relieves the prevaginal bleeding in menorrhagia.
CONCLUSION
Menorrhagia is a common complaint present in the women worldwide. Patient with heavy uterine bleeding along with complication which should managed instantly to stop further complication. Unani system of medicine has number of single as well as compound formulation, useful to manage this bleeding disorder. In this paper Sange jarahat ,Mazu sabz ,kath safed, Maeen was selected to treat the menorrhagia(Kasrat-e-tams) because of its Astringent, styptic, ant inflammatory and anti-septic properties and possess dry and cold temperament. Unani medicines which possess such properties tends to act as antifibrinolytics and stop bleeding.
Declaration Of Patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal.
Financial Support and Sponsorship
Nil
Conflict Of Interest
There are no conflicts of interest
REFERENCES
Shamsa Ahmad*, Dr Fahmeeda Zeenat, Suboohi Mustafa, Efficacy of Compound Unani formulation in the Management of Kasrat-e-Tams (Menorrhagia): A case series, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 4, 1290-1295 https://doi.org/10.5281/zenodo.15190168
10.5281/zenodo.15190168
